Ensuring A Covid 19 Safe Environment For Primary Healthcare

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This guideline is written to offer ideas to general practitioners (GP) and those working in out-patient clinic settings (OPD) on what precautionary measures to take to curb the spread of the Covid-19 disease
This is also to protect themselves when the relevant government authorities ease our lockdown. It may also be useful for other clinic settings like speciality clinics, antenatal clinics, dental clinics, etc. We are sharing it to the general public as it may be useful for patients and the community to think through some of these issues
Although many GP and primary care clinics have made significant changes to the way they work, we anticipate that as the number of patients increase back again, and we continue for longer periods, it will become challenging to maintain vigilance. Health care professionals cannot go back to the way we were working before and will have to significantly change how we function daily for many months or years
What we have done with the lockdown is just pushing the epidemic further away to give us time to prepare our medical response, change our behaviour and way of living. It is expected that Covid-19 cases will rebound episodically and we will have to control each wave until it gradually fades over time; this is estimated to be for at least another one year or two
We have written this guideline as some have expressed a need for more detailed ideas. The guideline is meant to protect the patient, the healthcare professional and the community. We welcome suggestions for improving this guideline
Note that information provided in this guideline does not take precedence over any guidelines from the Health Ministry
For those of us working in the health sector, we have to assume that every patient and accompanying family members are Covid-19 positive and the majority are likely to be asymptomatic. The key initiative will continue to be safe physical distancing, avoiding touching our face, preventing crowding, limiting physical contact, keeping our hands and surfaces clean at all times, using masks when in close proximity with others and taking other sensible precautions
The full guideline is available in this link
It is imperative that all staff in primary healthcare settings continue to receive training and periodic re-training to ensure a Covid-19-safe environment (including non-medical staff like cleaners and administrative staff).  The guideline covers the following areas:1. Strict personal hygiene practices including hand washing/disinfection, use of appropriate personal protective equipment (PPE), masks, face shields, etc
2. Front-door health checks (triage) and screening procedures, including options to wait in a parked vehicle outside the clinic
3. Preparing the clinic, waiting area and clinic rooms including safe distancing measures for waiting area, clinic rooms and other areas
4. Cleaning and disinfection procedures after every risk patient and at the end of the day
5. How to train and communicate to all patients and accompanying persons who come to the clinic
6. Measures to schedule staggered appointments (time-slots) for clinic visits and blood taking electronically to space out clinic visits
7. Additional suggestions for health staff and clinics regarding meal times, breaks, travelling, home safety, staff meetings and training
Attention to detail without getting paranoid, working as a team to prevent exhaustion and being innovative with protective gear is what will see us through these trying times
As health care professionals that continually support those who are ill and have chronic medical problems, we look to the public to offer their cooperation to make visits to primary care clinics as safe and meaningful as possible
It is only by working together, to protect and care for each other, that we can last the distance and return some sanity to our lives. As Dr Samin Sedghi Zadeh from Italy said: “Every person who can decide to follow all the rules can be the hero of this time”
DR AMAR-SINGH HSS is a senior consultant paediatrician. - Mkini

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